• Resuscitation · Oct 2022

    Multicenter Study

    Neurological Pupil Index and its association with other prognostic tools after cardiac arrest: A post hoc analysis.

    • Lorenzo Peluso, Mauro Oddo, Andrea Minini, Giuseppe Citerio, Janneke Horn, Eugenio Di Bernardini, Malin Rundgren, Alain Cariou, Jean-Francois Payen, Christian Storm, Pascal Stammet, Claudio Sandroni, and Fabio Silvio Taccone.
    • Department of Biomedical Sciences, Humanitas Huniversity, Pieve Emanuele, Milan, Italy; Department of Anaestesiology and Intensive Care, Humanitas Gavazzeni, Bergamo, Italy; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: lorenzopeluso80@gmail.com.
    • Resuscitation. 2022 Oct 1; 179: 259-266.

    IntroductionWe evaluated the concordance of the Neurological pupil Index (NPi) with other predictors of outcome after cardiac arrest (CA).MethodsPost hoc analysis of a prospective, international, multicenter study including adult CA patients. Predictors of unfavorable outcome (UO, Cerebral Performance Category of 3-5 at 3 months) included: a) worst NPi ≤ 2; b) presence of discontinuous encephalography (EEG) background; c) bilateral absence of N20 waves on somatosensory evoked potentials (N20ABS); d) peak neuron-specific enolase (NSE) blood levels > 60 mcg/L; e) myoclonus, which were all tested in a subset of patients who underwent complete multimodal assessment (MMM).ResultsA total of 269/456 (59 %) patients had UO and 186 (41 %) underwent MMM. The presence of myoclonus was assessed in all patients, EEG in 358 (78 %), N20 in 186 (41 %) and NSE measurement in 228 (50 %). Patients with discontinuous EEG, N20ABS or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20ABS, high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20ABS. Also, the higher the number of concordant predictors of poor outcome, the lower the observed NPi.ConclusionsIn this study, NPi ≤ 2 had moderate to high concordance with other unfavorable outcome prognosticators of hypoxic-ischemic brain injury. This indicates that NPi measurement could be considered as a valid tool for coma prognostication after cardiac arrest.Copyright © 2022 Elsevier B.V. All rights reserved.

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